From Detached Concern to Empathy: Humanizing Medical Practice

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Overview

Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. Halpern argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy.

How can doctors use empathy in diagnosing and treating patients rithout jeopardizing objectivity or projecting their values onto patients? Jodi Halpern, a psychiatrist, medical ethicist and philosopher, develops a groundbreaking account of emotional reasoning as the core of clinical empathy. She argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet she argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?

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Editorial Reviews

From the Publisher
"Halpern's book is the result of many years of experience with patients...Her skillful interweaving of philosophical, medical, and psychological writings on emotion and empathy with descriptions of real-life cases results in a book that is unusually vivid, moving, and persuasive."—USA Academic

"Jodi Halpern presents a scholarly and cogent exposition of the philpsophic underpinnings of the concept of empathy."—JAMA

"...may be rightly viewed as a seminal work in developing a scholarly understanding of the subject of empathy and will assist in the development of sound training and evaluation methods for imparting this skill to physicians."—American Medical Association

"I would recommend this book not as a manual, but as a vital reminder of how things should be, and as an insightful and philosophically educational analysis of how things probably are for the luckiest patients in our practice and hospitals"—Philip Berry in British Medical Journal

"This is a beautifully written and beautifully reasoned book. Physician-ethicist Jodi Halpern crafts on of the finest descriptions available of psychiatry's advance toward empathic involvement with patients. Intertwining psychiatry and ethics is no easy task. However, in Halpern's hands, a blend of formal research, philosophical modeling, and straight talk shows how neatly psychiatry and ethics work together."—Philip Candilis, M.D., in Psychiatric Services

"...this in an important book. I recommend it to physicians and members of medical faculties for whom its subject matter is important. It is a serious essay on subjectivity, a topic about which we will be seeing more in the coming years. It repays the work of reading it."—Eric Cassell, M.D., in The New England Journal of Medicine


"Dr. Jodi Halpern has written a remarkable book articulating a view of clinical empathy that has practical and philosophical implications for all helping professionals, as well as for normative and relational ethics within the helping professionals. I believe that this book should be required reading for all practicing physicians, ethicists, nurses, social workers, other helping professionals, and students in these fields. Dr. Halpern powerfully illuminates a moral vision of helping that resists paternalism and unexamined emotional straitjackets that prevent professionals from seeing and responding skillfully to vulnerability and suffering."—Cambridge Quarterly of Healthcare Ethics

"From Detached Concern to Empathy is a sophisticated, rigorous, and extremely well annotated defense of emotional realism in the patient-physician relationship. Bringing philosophy (both the analytic and continental traditions), psychoanalytic theory, and cultural criticism to the subject of emotion, Halpern's analysis is both encompassing and exact. Her demonstration of the impact of social forces, historical precedent, and economic factors on interpersonal dynamics within the structure of medicine, combined with an exploration of the underlying ideology recalls the richness and value of critical social theory. But more than a critical investigation, Halpern includes a positive project: physicians' development of empathic engagement with patients as a means to maintain humanity in medicine under the challenging organizational, political, and economic conditions physicians currently face."—Matthew Rottnek, The Mount Sinai School of Medicine, APA Newsletter

"Halpern's book is the result of many years of experience with patients...Her skillful interweavign of philosophical, medical, and psychological writings on emotion and empathy with descriptions of real-life cases results in a book that is unusually vivid, moving, and persuasive."—USA Academic

Doody's Review Service
Reviewer: R. Waid Shelton, M.D.(University of Alabama at Birmingham)
Description: This book provides the philosophical and psychological basis for physicians' empathy with patients, instead of their previously held position of detached concern.
Purpose: The book's purpose is to present the argument that doctors can better understand and care for their patients if they are emotionally touched by those patients. The book provides a useful theoretical basis for the growing trend of physicians forming a relationship with patients, even before collecting data from them.
Audience: The audience includes those physicians who are interested in this theoretical basis, especially those whose interest is the doctor-patient relationship.
Features: The book takes the reader through the major historical positions regarding the doctor-patient relationship. A wide range of opinions are discussed. It concludes with support for the author's position that empathy with the patient improves the physician's understanding of the patient's response to his or her pathophysiology. Although two others are mentioned, the author returns frequently to one clinical case. Reference to more clinical material might have helped the reader see the author's argument from different perspectives.
Assessment: This book supplies the psychological and philosophical basis for physician empathy with the patient, a position in harmony with the recent trends of doctor-patient relationships. In doing so, it fills an important niche in our understanding of those relationships. The groundwork for the author's position is thoroughly laid out, and her arguments are convincing.

3 Stars from Doody
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Product Details

  • ISBN-13: 9780199768707
  • Publisher: Oxford University Press, USA
  • Publication date: 8/29/2011
  • Edition description: New Edition
  • Pages: 196
  • Sales rank: 452,299
  • Product dimensions: 6.00 (w) x 9.20 (h) x 0.50 (d)

Meet the Author

Jodi Halpern, M.D., Ph.D., is Associate Professor of Bioethics and Medical Humanitites at the University of California, Berkeley. She received her B.A., M.D. and Ph.D. in philosophy from Yale University, did an internship at the UCLA/Wadsworth VA Medical Centers, and completed a residency in psychiatry at the UCLA Neuropsychiatric Institute. She won the Louis Nahum Prize for her medical school thesis, and her Ph.D. thesis was awarded the Porter Prize, which is given to the outstanding dissertation at Yale of general interest across the disciplines.

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Table of Contents

1 Failures of Emotional Communication in Medical Practice 1
2 Managing Emotions as a Professional Ideal 15
Detachment to Avoid the Errors of Sympathy 15
The Tradition of Sympathy 19
The Ideal of Objectivity 21
Avoiding Emotional Errors 26
Emotions and Cognition 29
3 Emotional Reasoning 39
Associational Linking 40
"Gut Feelings" 44
Emotional Inertia 49
Moods and Temperament 53
The Strategic Nature of Emotions 57
4 The Concept of Clinical Empathy 67
Clinical Empathy as Detached Insight 68
Aesthetics and the Origins of the Concept of Empathy 74
Psychoanalytic Views of Empathy as Affective Merging 77
A Model of Clinical Empathy as Emotional Reasoning 85
5 Respecting Patient Autonomy: From Non-Interference to Empathy 101
Respecting Autonomy: Beyond Non-Interference 102
Beyond Negative Autonomy: Kant on Deliberative Freedom 106
Autonomy versus Detachment 109
Suffering, Empathy, and the Interpersonal Basis of Autonomy 111
Kantian Theory and Positive Obligations to Share Ends 118
The Complex Relationship Between Empathy and Respecting Autonomy 123
6 Cultivating Empathy in Medical Practice 129
From Certainty to Curiosity 129
Emotional Irrationality Revisited: Finding the Therapeutic Opportunity 136
Regaining Mental Freedom 138
Non-Abandonment 141
Bibliography 149
Index 163
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